A longitudinal study of dental health from the age of 14 to 41

The aim of present study was to longitudinally follow dental health from the age of 14 to 41. Originally an entire age group attending one of the compulsory schools in the city of Orebro, Sweden was selected and 115 children born in 1962 were included in the study. At the last examination 27 years later, 73 (63%) individuals, 35 males and 38 females, could still be located and were willing to participate. The drop out analysis did not show any statistical difference between the drop-outs and this final material. All participants had experienced a comprehensive whole population based preventive dental care, free of charge, during the first 19 years of their lives, and after that the increment of dental diseases had been limited. Only two individuals were diagnosed with chronic periodontitis at 41, and 70% of all DMFS registered at 41 were present already at 19. This positive development during adulthood seemed to be unrelated to socio-economic status. In addition, the dental health at 41 did not seem to be obviously influenced by if the participants, as adults, had paid yearly visits to the dentist or not, and there was no evidence supporting that regularly seeing a dental hygienist or using daily inter-dental cleaning would improve dental health. The most obvious difference in dental health at 41 was due to gender where e.g. the experience of proximal caries and bleeding after probing were twice as frequent in males as in females. Based on the results of the present study it can be concluded that uncritically abandoning whole population preventive strategies might not be in the best interest of public dental health. Furthermore, if already existing dental care resources should be reallocated for a better long-term dental health investment it should be on the expense of the young adults to the benefit of the young teenagers (as population sub-groups) and not the other way around based on individual indications.     

Aircraft noise and incidence of hypertension--gender specific effects

Recent studies show associations between aircraft noise and cardiovascular outcomes such as hypertension. However, these studies were mostly cross-sectional and there are uncertainties regarding potential gender differences as well as sensitive subgroups. In this study, we investigated the cumulative incidence of hypertension in relation to aircraft noise exposure among Swedish men and women living in Stockholm County. A total of 4721 subjects, aged 35–56 at baseline, were followed for 8–10 years. The population was selected according to family history of diabetes, which was present for half of the subjects. The exposure assessment was performed by geographical information systems and based on residential history during the period of follow-up. Blood pressure was measured at baseline and at the end of follow-up. Additional information regarding diagnosis and treatment of hypertension as well as various lifestyle factors was provided by questionnaires. In the overall population, no increased risk for hypertension was found among subjects exposed to aircraft noise ≥50 dB(A) L_den; relative risk (RR) 1.02 (95% CI 0.90–1.15). When restricting the cohort to those not using tobacco at the blood pressure measurements, a significant risk increase per 5 dB(A) of aircraft noise exposure was found in men; RR 1.21 (1.05–1.39), but not in women; RR 0.97 (0.83–1.13). In both sexes combined, an increased risk of hypertension related to aircraft noise exposure was indicated primarily among those reporting annoyance to aircraft noise; RR 1.42 (1.11–1.82). No consistent effect modification was detected for any of the cardiovascular risk factors under investigation although a family history of diabetes appeared to modify the risk in women. In conclusion, the results suggest an increased risk of hypertension following long-term aircraft noise exposure in men, and that subjects annoyed by aircraft noise may be particularly sensitive to noise related hypertension.     

CAPD peritonitis induces the production of a novel peptide, daintain/allograft inflammatory factor-1.

OBJECTIVES: To study the occurrence of a novel macrophage-derived peptide, daintain/allograft inflammatory factor-1 (AIF-1), in dialysate from continuous ambulatory peritoneal dialysis (CAPD) patients at commencement and after a follow-up period of therapy and during peritonitis. In addition, we studied peptide production in response to bacterial stimulation of monocytes and macrophages. DESIGN: Peritoneal fluid and supernatants from cells stimulated with different bacteria were analyzed for daintain/AIF-1. PATIENTS AND SETTING: Peritoneal fluid was obtained from 5 patients at commencement of CAPD therapy and during 8 weeks' follow-up, and from 14 patients (10 males, 4 females) during CAPD peritonitis and during the noninfected steady state. All patients were admitted to the Karolinska Hospital. A human monocyte cell-line, THP-1 was differentiated to macrophages, and both monocytes and macrophages were stimulated with live and heat-inactivated Escherichia coli, Staphylococcus aureus, and S. epidermidis. Cells were also stimulated with interleukin (IL)-1beta and interferon gamma (IFNgamma). Daintain/AIF-1 was analyzed with radioimmunoassay technique and IL-8 with enzyme immunoassay technique. RESULTS: An increased production of daintain/AIF-1 was observed in the first spent dialysate in the newly started CAPD patients, with a decrease during the follow-up period (p < 0.05). During peritonitis, the first spent dialysate revealed significantly higher levels of daintain/AIF-1 (3.9 ng/mL) compared to the noninfected state (0.8 ng/mL), with production normalizing after 9-12 days. Bacterial stimulation with E. coli, S. aureus, or S. epidermidis induced higher daintain/AIF-1 response in monocytes compared to macrophages (p < 0.05). Live bacteria induced higher production of the peptide compared to heat-inactivated bacteria (p < 0.05). Interleukin-1beta and IFNgamma were used to stimulate monocytes and macrophages; however, no daintain/AIF-1 production was found, although increased IL-8 levels were detected. CONCLUSION: CAPD peritonitis induces a high and prominent daintain/AIF-1 response. Bacteria are able to induce a response of the peptide from monocytes and macrophages, and it is likely that the virulent parts of the bacteria are heat-labile structures. The early rise in daintain/ AIF-1 might be used as a marker of CAPD peritonitis.     

Ahlbäck grading of osteoarthritis of the knee: poor reproducibility and validity based on visual inspection of the joint

BACKGROUND: Staging of osteoarthritis (OA) of the knee is commonly based on the Ahlb?ck classification. Its value has been questioned, however. We therefore evaluated the reproducibility and validity of this classification of knee osteoarthritis. PATIENTS AND METHODS: 48 patients (48 knees) (medial OA: n = 30; lateral OA: n = 8) operated with total knee prostheses were studied. Weight-bearing radiographs were evaluated twice by 4 observers. Presence of bone attrition on radiographs was compared with observations of the resected parts of the distal femur and proximal tibia. RESULTS: When the same observer classified the radio-graphs twice according to Ahlb?ck, the repeatability was fair in both medial OA (kappa values = 0.15-0.65) and lateral OA (0.59-0.76), and between different observers it was poor (kappa: 0.1). Comparison between radiographic classification and classification based on visual inspection of the bone pieces removed during arthroplasty revealed an acceptable sensitivity in both medial (67-95%) and lateral OA (43-86%), but the specificity was low (medial: 11-67%; lateral: 25-75%). INTERPRETATION: The main problem with the Ahlb?ck classification was that a joint space could often be seen radiographically despite the presence of bone attrition on the preparations. According to our study, conventional radiographs do not give sufficient information for correct grading.     

Health-related quality of life is related to COPD disease severity

Background  

The aim of this study was to evaluate the association between health-related quality of life (HRQL) and disease severity using lung function measures.     

αEβ7 Expression on CD8+ T-Cells in COPD BAL Fluid and on TGF-β Stimulated T-Cells <Emphasis Type="BoldItalic">In Vitro</Emphasis>

The airway inflammation in patients with COPD shows increased numbers of CD8+ T-cells. Until now few studies have shown any functional data indicating a role for these cells in the pathogenesis of COPD. This paper focuses on a subset of CD8+ T-cells present in human lung, the intra-epithelial lymphocytes expressing the integrin αEβ7, and their presence in bronchoalveolar lavage fluid from COPD patients. In this study we demonstrate that 64–89% of the CD8+ T-cells in bronchoalveolar lavage fluid from COPD patients are positive for CD103, the alpha subunit of αEβ7. We also present an in vitro system in which it is possible to differentiate peripheral T-cells into a phenotype resembling the one found in bronchoalveolar lavage fluid, i.e., CD8+ CD103+. In this in vitro system we demonstrate that, in addition to TGF-β1, cell-to-cell interaction between the T-cell and an antigen-presenting cell represented here by the monocyte, is crucial for a rapid, high and sustained expression of CD103. The signal provided by the monocytes is shown to be mediated through LFA-1 on the T-cell. Furthermore, differentiation of CD8+ T-cells by TGF-β₁ and monocytes results in down regulation of INF-γ, TNF-α and GM-CSF production. IL-8 production is, however, retained in the αEβ7 expressing cells. We see this work as an initiation on the quest for a functional characterization of one of the different types of CD8+ T cells present in COPD. In the longer perspective we hope this can lead to an increased understanding of how these cells can contribute to the disease pathology.     

Economic burden on families of childhood type 1 diabetes in urban Sudan

The aims of this study were to estimate the direct costs of childhood diabetes in a low income country, Sudan, and to assess the effectiveness of care paid for by the families. For this purpose, socio-economic and demographic data on families were obtained from the parents of 147 children with type 1 diabetes, attending public or private clinics in Khartoum State, Sudan. The median annual income of the families of diabetic children was US dollars (US$) 1222 (range 0-14,338) of which 16% was received as financial help from relatives and friends. The median annual expenditure of diabetes care was US$ 283 per diabetic child of which 36% was spent on insulin. Of the family expenditure on health, 65% was used for the diabetic child. Families of diabetic children who were attending private clinics had a significantly higher total expenditure on health and home blood glucose monitoring than those who were attending the public clinics. However, there was no difference in total income between the two groups and glycaemic control was poor in 86% of the patients, regardless of whether care was being given by private or public clinics. The occurrence of the disease and its poor control appeared to exert a negative impact on the school performance of the diabetic child. In conclusion, the low direct costs reflect the minimal care given to the diabetic patients. Under the present economic conditions, families pay a considerable part of their income to sponsor the health of their diabetic children and receive little support other than that from relatives and friends. The present organization of diabetes care does not provide the patient with empowerment, knowledge and self-care ability. Well-trained diabetic teams and education programs may improve this situation.     

Clinical application of a new three-dimensional radiological classification of lumbar disc herniations

The results after lumbar discectomy are usually satisfactory. However, there is a group of patients with less favorable result. The predictive factors affecting the result are not fully understood. In this paper a new radiological classification for lumbar disc herniations has been used in order to study the predictive value of the type and location of the herniation for the postoperative result. 142 patients operated with standard lumbar discectomy were included in the study. The preoperative CT-scans were used to classify the disc herniations in the transverse, sagittal and longitudinal directions and the size of the herniations were calculated. At a mean of 7.7 years postoperatively a patient administrated questionnaire was used to compare the clinical results to the radiological findings. A significantly smaller size of the lumbar disc herniation was found with increasing age, which could reflect the increased degeneration of the disc. Patients with a wide transverse distribution of the herniation seem to have a less favorable postoperative outcome in terms of higher rate of repeat surgery (p = 0.056). No other correlations were found.     

Comparison of lung volume reduction surgery and physical training on health status and physiologic outcomes: a randomized controlled clinical trial

STUDY OBJECTIVES: In 1996, researchers in Sweden initiated a collaborative randomized study comparing lung volume reduction surgery (LVRS) and physical training with physical training alone. The primary end point was health status; secondary end points included survival and physiologic measurements. DESIGN: After an initial 6-week physical training program, researchers' patients were randomized to either LVRS (surgical group [SG]) with continued training for 3 months, or to continued training alone (training group [TG]) for 1 year. SETTING: All seven thoracic surgery centers in Sweden. PATIENTS: All patients in Sweden with severe emphysema fulfilling inclusion criteria for LVRS. INTERVENTIONS: Patients randomized to surgery underwent a median sternotomy, except for a few patients in whom thoracotomy or video-assisted thoracoscopy were performed. In the TG, supervised physical training continued for 1 year; in the SG, supervised physical training continued for 3 months postoperatively. MEASUREMENTS AND RESULTS: Fifty-three patients were included in each group. Six in-hospital deaths occurred after surgery (12%), and one more death occurred during follow-up. Two deaths occurred in the TG. The difference in death rates between the groups was not statistically significant. Health status, as measured by St. George Respiratory Questionnaire (SGRQ) [total scale score mean difference at 1 year, 14.7; 95% confidence interval (CI), 9.8 to 19.7] as well as by the Medical Outcomes Study Short-Form General Health Survey (physical function scale score mean difference at 1 year, 19.7; 95% CI, 12.1 to 27.3) was improved from baseline in the SG compared with the TG. FEV(1), residual volume, and shuttle walking test values also improved in the SG but not in the TG after 6 months and 12 months. CONCLUSIONS: In severe emphysema, LVRS can improve health status in survivors but is associated with mortality risk. The effects are stable for at least 1 year. Physical training alone failed to achieve a similar improvement.